Risk Adjustment Auditor II

** Build a career with purpose. Join our*
* ** to create a person-focused and economically sustainable health care system.
** Every day, Cambia’s dedicated team of Risk Adjustment Auditors  is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Auditors perform Retrospective/Prospective chart reviews both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting.  They also Identify trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies – all in service of making our members’ health journeys easier.  

Then this role may be the perfect fit.
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* Qualifications:

** Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required. RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.  
** Skills and Attributes:*
* * Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
* Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.
* Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
* Demonstrated ability to identify and communicate trends in provider coding and documentation.
* Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
* Effective verbal and written communication skills.
* Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
* Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
* Demonstrated ability to provide proactive and creative solutions to business problems.
* Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
* Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
* Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
* Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
* Supports and actively participates in process and quality improvement initiatives.
* Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
* Consistently meets departmental performance and attendance requirements.
* Serves as a mentor to Risk Adjustment Auditor I staff.
* Assists with special projects such as risk mitigation reviews.
* Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
* Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program.  Assists with implementation activities as a result of regulatory changes to the Program.
* Work alongside diverse teams building cutting-edge solutions to transform health care.
* Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
* Grow your career with a company committed to helping you succeed.
* Give back to your community by participating in Cambia-supported outreach programs.
* Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
* Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
* Annual employer contribution to a health savings account.
* Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
* Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
* Up to 12 weeks of paid parental time off…